NARRATIVE DISPUTES OVER BRAZIL–CUBA HEALTH COOPERATION AND THEIR INSTITUTIONAL EFFECTS ON BRAZIL’S SUS IN THE 21ST CENTURY

Abstract

This article examines, within the 21st-century context, how Brazil–Cuba health cooperation was publicly constructed and contested through competing narratives and how such disputes were associated with institutional effects on Brazil’s Unified Health System (SUS), with implications for the effectiveness of the constitutional right to health. A qualitative design is employed, combining documentary analysis and content analysis applied to a corpus of institutional acts and communications, public statements, and media coverage around key decision-making milestones. The analytical strategy draws on narrative policy analysis and problem representation approaches to identify problem framings, characters, causal attributions, and legitimacy criteria structuring the debate. Findings show recurrent frames centered on: (i) access and equity; (ii) sovereignty and ideology; (iii) regulation and professional quality; and (iv) labor, rights, and contractual arrangements. The competition and shifting predominance of these frames reoriented public priorities and increased legitimacy costs for specific policy instruments, particularly during institutional turning points, with potential consequences for continuity of care in vulnerable territories. The article concludes that discursive disputes are part of the policy mechanism itself—shaping policy maintenance, reform, or rupture—and should be incorporated into health policy analysis and into strategies to safeguard universality and access within SUS.